Selecting indicators for the quality of cardiac care at the health system level in Organization for Economic Co-operation and Development countries

Background. Cardiovascular (CV) diseases are major causes of morbidity and death in adults in the world. Major differences have been reported in the management strategies and the outcome of CV diseases within and between countries. To better understand and address these differences, there is a need for quantitative information on patient management, outcome, and prognosis. Objective. This article describes the development of a set of quality indicators for cardiac care and summarizes work undertaken by the Cardiac Care Panel of the OECD Health Care Quality Indicators Project. Methods. A list of 61 potential indicators was identified through a literature search, review of national measurement systems, and nomination from countries participating in the project. The Cardiac Care Panel then used a modified Delphi process developed originally by RAND to select indicators. Panel members individually rated each indicator on a scale of 1-9 for scientific soundness and importance. All indicators receiving scores of 7 or more for both importance and soundness were included in the final set. Results. Seventeen cardiac indicators were selected for the final set of indicators from the following areas: acute coronary syndromes, cardiac interventions, secondary prevention, and congestive heart failure. Conclusions. The final set of 17 indicators selected by the Cardiac Care Panel constitutes a comprehensive set of measures for the most relevant domains of CV care. Nevertheless, gaps remain in the area of primary prevention and in particular in areas with rapidly changing technology and improving treatment options.